Department of Paediatric Surgery, Rainbow Children's Hospital Hyderabad 500004, Hyderabad, India.
Department of Paediatric Surgery, Rainbow Children's Hospital Hyderabad 500004, Hyderabad, India.
J Pediatr Surg. 2021 Dec;56(12):2215-2218. doi: 10.1016/j.jpedsurg.2020.11.029. Epub 2020 Dec 5.
BACKGROUND/PURPOSE: Intra hospital transfer of sick newborns is known to cause adverse events with potential morbidity. Interventions at the bedside in a sick neonate can reduce the need for transport and in turn, potential hazards of transfer. Our single institute experience of performing bedside laparotomies in unstable newborns is reported here.
Seven-year data was collected from electronic medical records. This was a retrospective comparative study with level III evidence. Twenty-eight neonates operated at bedside for intraabdominal sepsis due to Necrotising Enterocolitis (NEC), Spontaneous Intestinal Perforation (SIP), complicated meconium ileus and perforation secondary to atresias were included Group A. Group B had 60 neonates operated for similar indications in the conventional operation theatres.
The average corrected gestational age at surgery, associated co-morbidities, average volume of blood loss and duration of surgery were compared between the groups. Group A had lower weight at surgery (1098 vs 1872 gs), greater percentage of neonates on inotropic support (78% vs 20%) with requirement of High Frequency Ventilation (HFO) (50% vs none). A quarter of neonates (7 of 28) in Group A had NEC Totalis as against only one case in group B. There was 25% survival in group A and 76.67% in group B. The lower survival in group A can be attributed to lower weight at surgery, higher inotrope requirement and need for unconventional modes of ventilation.
Bedside laparotomy is a feasible option in unstable neonates deemed unsuitable for transport.
背景/目的：众所周知，医院内转运患病新生儿会导致不良事件，并可能导致发病。在患病新生儿床边进行干预可以减少转运的需求，从而降低转运的潜在风险。我们在此报告在不稳定新生儿中进行床边剖腹手术的单中心经验。
从电子病历中收集了 7 年的数据。这是一项具有 III 级证据的回顾性对比研究。28 例因坏死性小肠结肠炎（NEC）、自发性肠穿孔（SIP）、复杂胎粪性肠梗阻和因闭锁穿孔的新生儿因腹腔内感染在床边接受剖腹手术，归入 A 组。B 组有 60 例新生儿因类似原因在常规手术室接受手术。
比较了两组新生儿手术时的平均校正胎龄、合并症、平均失血量和手术持续时间。A 组手术时体重较低（1098 与 1872 克），需要正性肌力支持的新生儿比例较高（78%与 20%），高频通气（HFO）的需求较高（50%与无）。A 组中有四分之一（28 例中的 7 例）新生儿为 NEC 全结肠炎，而 B 组中仅有一例。A 组的存活率为 25%，B 组为 76.67%。A 组存活率较低可归因于手术时体重较低、正性肌力支持需求较高以及需要非常规通气模式。
对于不适合转运的不稳定新生儿，床边剖腹手术是一种可行的选择。
